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Thank you for your interest in applying to become a Heart of Illinois United Way (HOIUW) Partner Agency. Please review the application in its entirety to ensure a complete submission. Contact Nicole Frederick, VP of Community Investment at (309) 674-5181 or nicole.frederick@local., with any questions.

To be considered as a Partner Agency, the following requirements must be met:

▪ Registration as an Illinois not-for-profit organization;

▪ Certification as a tax-exempt, not-for-profit organization; under section 501(c)(3) of the US IRS Code;

▪ Implement uniform standards of accounting and reporting (accounting principles generally accepted in the United States; no cash basis of accounting);

▪ Have an annual 3rd party audit with unqualified opinion;

▪ File an annual Federal Internal Revenue Form 990;

▪ Demonstrate agency’s financial stability and funding diversity;

▪ Operate with a Board of Directors and executive management with approved agency by-laws and personnel/administrative policies that provide local oversight (within the HOIUW service area - Peoria, Tazewell, Woodford, Marshall, Stark, and Putnam counties);

▪ Have an agency mission that aligns with the HOIUW mission;

▪ Provides health/human services in the HOIUW service area;

▪ Have a minimum of two years of providing services in the HOIUW service area; and

▪ Provide programming/services that align with the HOIUW Community Needs Assessment and strategic investment areas.

Please Provide a copy of the items listed below as application attachments:

▪ Copy of Registration as an Illinois not-for-profit organization;

▪ Copy of Certification as a tax-exempt, not-for-profit organization; under section 501(c)(3) of the US IRS Code;

▪ Copy of agency’s current Board of Directors and agency organizational chart;

▪ Copy of Agency’s current by-laws and personnel and/or administrative policies;

▪ Copy of most recent agency audit performed by a Certified Public Accountant with an unqualified opinion;

▪ Copy of most recent Form 990 filed with the IRS;

▪ Copy of agency budget for the current fiscal year; and

▪ If your agency has revenue from client/participant fees for programming/services, please provide a copy of policies relating to such fees.

Instructions for Application Submission:

▪ Please supply only the information requested in the application.

▪ Submit ten (10) copies of your application to:

Nicole Frederick, VP of Community Investment

Heart of Illinois United Way

509 W. High Street, Peoria, IL 61606

▪ Ensure all items requested above are attached to your agency’s application.

▪ Applications will be accepted until NOON on Friday, May 28, 2021.

▪ Agencies will be notified of their application status in the summer of 2021.

▪ Information regarding participation in the annual campaign and Community Impact Fund will be provided after acceptance as a new Partner Agency.

I. GENERAL INFORMATION

|Name of Agency: | |

|Address: | |

|Business Phone and Website Address: | |

| |Name: | |

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|Executive Director: | | |

| |Email: | |

| |Phone: | |

| |Name: | |

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|Agency Contact Person and Title: | | |

|*If different from Executive Director | | |

| |Email: | |

| |Phone: | |

|Agency Mission: | |

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|Years of Operation: | |

|List of Programs or Services Provided: | |

|Geographic area served by Agency: | |

|Specify counties or communities | |

II. PROGRAM INFORMATION

This information should relate to the specific program(s) for which funds (when grant opportunities become available) may be requested from the HOIUW Community Impact Fund. If your agency will not participant in the Community Impact Fund, please answer only questions 1, 2, and 7. Use additional space if needed – however, please be concise in responses.

|1. Describe your agency’s program, including client population, number served, percentage of low-income individuals, and specific services |

|provided: |

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|2. Describe how your agency and its programming align with the 2020 HOIUW Community Needs Assessment and Impact Areas (Education, Financial |

|Stability and Health). |

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|3. If you intend to apply for funding (when grant opportunities become available) through the Community Impact Fund, please list the current |

|goals and objectives of the program(s) for which an application will be submitted. |

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|4. How does your agency evaluate and measure the effectiveness of its programming? |

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|5. List at least two measureable outcomes/results achieved by your agency’s programming during the last year. |

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|6. Please indicate the number of staff, by position, for this program. Indicate the experience and educational background of key staff. |

|Please describe any program volunteers and how they are utilized. |

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|7. Specifically, how will funds received either through the HOIUW Community Impact Fund and/or annual campaign be used within your agency? |

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III. ADDITIONAL INFORMATION

Please provide any additional information that would be helpful in the consideration of your agency’s application.

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